30 April 2004
There is a tendency when discussing NHS waiting lists to talk in terms of numbers, as if they were the only things that matter.
It is easy to forget that behind these figures lie thousands of people in pain, perhaps unable to work or look after themselves without help from their relatives, the state or both. Their conditions may not be life-threatening but the misery can make the months waiting for their operation seem like a lifetime.
Last week's announcement that the government would buy a further 25,000 operations from the independent sector over the coming year offers these people some hope. It is also significant for the NHS, the independent sector and consultant surgeons.
The contracts with Nuffield Hospitals and Capio Healthcare UK are not the first bulk purchase deals handed to the independent sector by the Department of Health – those were awarded last September – but they confirm a notable shift in the market for non-emergency surgery in England.
Political expediency was the driving force behind Labour's initial decision to use the independent sector to cut waiting lists. The NHS did not have enough doctors and nurses to reduce the backlog while private and not-for-profit hospitals were sitting on spare capacity. It was a pragmatic move but the government's thinking has developed far beyond that. Although the deals announced to date are short-term contracts, ministers are adamant that the new partnerships are permanent.
Nigel Edwards, NHS Confederation policy director, says the signs are clear. 'Why would it be short-term? Both the Tories and New Labour seem to agree that there should be a plurality of provision in elective surgery, though they might not agree on the reasons why it is needed. Once they have been established and shown to work, I can't see why they would not be used, unless in the future there is a large amount of capacity that is not needed.'
However, in this scenario Edwards believes the NHS would not necessarily stop buying routine surgery from the independent sector units. If this were to continue it would, of course, entail a scaling down or even closure of some NHS hospitals, a thought that worries the likes of Unison.
This might sound like good news for the UK independent sector and consultant surgeons, who might have expected a bonanza in private fees, but it is not. When assessing bids for the first wave of contracts last September, the department decided that UK-based providers were too expensive and awarded the major contracts to cheaper, overseas bidders. The NHS has paid up to 40% more for operations in private hospitals while a Norwich Union Healthcare study last December found that NHS consultants' private fees were up to 60% higher than their international peers.
Health Secretary John Reid hoped to drive down these costs by upping the competitive ante and it seems to be working. Last week's deals were awarded to UK-based operators (though Capio has a Swedish parent company) on the basis that the care would not cost more than NHS prices.
In this more competitive market, British surgeons are feeling squeezed. British Medical Association private practice committee leader Derek Machin told the FT that surgeons might simply walk away rather than accept lower fees.
But the department is not worried. One insider points out that doctors and nurses would be brought in from across Europe to execute the contracts and does not believe local surgeons would simply give up private work.
With both main parties now agreed on using independent health care firms, the sector will be looking to increase its reach into the NHS. Some health insurers, for example, do not look after patients directly, as Bupa does, but 'buy in' care from other companies. They may believe they can take on a commissioning role in the NHS.
Edwards believes this 'is some way off' but he adds: 'Some could offer help on commissioning. The NHS is short of actuarial skills and if I was in one of these organisations I would be saying to the Department of Health: “We have the expertise you need”.'
He believes an extension of the independent sector reach is inevitable. 'The question is whether someone would come in to run emergency services. I think that is a less attractive bit of the market but I expect to see more independent sector involvement rather than less.' Patients may have to get used to being treated by a plurality of providers in the future but, if the government's initiative works, they may also have to get used to being treated more quickly.
PFapr2004
